Outcome of Plate Augmentation in Management of Tibial Nonunion After Intramedullary Nailing

Haytham Hemeda; Osama Essawy

doi:doi:10.11648/j.ajbls.20221002.19

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Outcome of Plate Augmentation in Management of Tibial Nonunion After Intramedullary Nailing

Haytham Hemeda, Osama Essawy

Published in American Journal of Biomedical and Life Sciences (Volume 10, Issue 2)

Received: 28 March 2022 Accepted: 18 April 2022 Published: 26 April 2022

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Abstract

Background: Despite the multitude of studies on non union no clear criterion has been established for declaring a fracture as non united. A diagnosis of non union is unjustified, however, until clinical or radiographic evidence shows that healing has ceased and that union is highly improbable. A fracture of the shaft of a long bone should not be considered a non union until at least 6 months after the injury. The incidence of non union in the long bone varies with each bone and with methods of treating acute fractures. More recently, the tibia probably is the most frequent site of non union. Nonunion following intramedullary fixation of tibial fractures is a challenge. Although reamed exchange nailing results are encouraging with union rates, exchange nailing could be extremely challenging due to situations when nail removal is difficult. Augmentation plates gained popularity in management of femoral nonunion with few reports in tibial nonunion. The aim of the current study is to present our results in augmentation plate in management of tibial nonunion with intramedullary nail. Patient and methods: From 2017 till 2021, 20 cases of nonunited tibial fractures fixed by IM nails was included. Augmentation plate without removing the nail in addition of autogenous iliac graft. Results: Union was obtained in all the cases (20 cases) in an average time of about 6.22 months (range 3-12 months). Complications are few included 3 casea of superficial infection and parasthesia at iliac graft site. Conclusion: Plate augmentation without removal of IM nail is a good option in management of aseptic nonunion tibia with excellent results and few complications.

Published in	American Journal of Biomedical and Life Sciences (Volume 10, Issue 2)
DOI	10.11648/j.ajbls.20221002.19
Page(s)	55-57
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2022. Published by Science Publishing Group

Keywords

Nonunion, Nail, Tibia, Plate, Augmentation

References

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[2]	Brinker MR, Hanus BD, Sen M, O'Connor DP. The devastating effects of tibial nonunion on health-related quality of life. J Bone Joint Surg Am. 2013 Dec 18; 95 (24): 2170-6.
[3]	Kreder HJ. Tibial nonunion is worse than having a myocardial infarction: Commentary on an article by Mark R. Brinker, MD, et al.: "The devastating effects of tibial nonunion on health-related quality of life". J Bone Joint Surg Am. 2013 Dec 18; 95 (24): e1991.
[4]	Bell A, Templeman D, Weinlein JC. Nonunion of the Femur and Tibia: An Update. Orthop Clin North Am. 2016 Apr; 47 (2): 365-75.
[5]	Rupp M, Biehl C, Budak M, Thormann U, Heiss C. Diaphyseal long bone nonunions—types, aetiology, economics, and treatment recommendations. Int Orthop. 2018; 42 (2): 247-58.
[6]	Sanders R, Jersinovich I, Anglen J, DiPasquale T, Herscovici D. The treatment of open tibial shaft fractures using an interlocked intramedullary nail without reaming. J Orthop Trauma. 1994: 8: 504-10.
[7]	Hierholzer C, Friederichs J, Glowalla C, Woltmann A, Bühren V, Rüden Cv. Reamed intramedullary exchange nailing in the operative treatment of aseptic tibial shaft nonunion. Int Orthop. 2017; 61: 1647-53.
[8]	Medlock G, Stevenson M, Johnstone A. Uniting the un-united: should established non-unions of femoral shaft fractures initially treated with IM nails be treated by plate augmentation instead of exchange IM nailing? A systematic review. Strateg Trauma Limb Reconstr. 2018; 13 (3): 119-28.
[9]	Ueng S, Chao E, Lee S. Augmentative plate fixation for the management of femoral nonunion after intramedullary nailing. J Trauma. 1997; 48 (4): 640-4.
[10]	Bellabarba C, Ricci W, Bolhofner B. Results of indirect reduction and plating of femoral shaft nonunions after intramedullary nailing. J Orthop Trauma. 2001; 15 (4): 254-61.
[11]	Chiang C, Johnson J, Tarkin I, Siska P, Farrell D, Mormino M, et al. Plate augmentation for femoral nonunion: more than just a salvage tool? Arch Orthop Trauma Surg. 2016; 136 (2): 149-56.
[12]	Birjandinejad A, Ebrahimzade MH, Ahmadzadeh-Chabock H. Augmentation plate fixation for the treatment of femoral and tibial nonunion after intramedullary nailing. Orthopedics. 2009; 32 (6): 409-12.
[13]	Nadkarni B, Srivastav S, Mittal V, Agarwal S. Use of locking compression plates for long bone nonunions without removing existing intramedullary nail: review of literature and our experience. J Trauma. 2008; 65 (2): 482-6.
[14]	Ateschrang A, Karavalakis G, Gonser C. Exchange reamed nailing compared to augmentation compression plating leaving the inserted nail in situ in the treatment of aseptic tibial non-union: a two-centre study. Wien Klin Wochenschr. 2013; 125: 244-53.
[15]	Tall M. Treatment of aseptic tibial shaft non-union without bone defect. Orthop Traumatol Surg Res. 2018 Feb; 104 (1S): S63-S69.

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APA Style

Haytham Hemeda, Osama Essawy. (2022). Outcome of Plate Augmentation in Management of Tibial Nonunion After Intramedullary Nailing. American Journal of Biomedical and Life Sciences, 10(2), 55-57. https://doi.org/10.11648/j.ajbls.20221002.19

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ACS Style

Haytham Hemeda; Osama Essawy. Outcome of Plate Augmentation in Management of Tibial Nonunion After Intramedullary Nailing. Am. J. Biomed. Life Sci. 2022, 10(2), 55-57. doi: 10.11648/j.ajbls.20221002.19

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AMA Style

Haytham Hemeda, Osama Essawy. Outcome of Plate Augmentation in Management of Tibial Nonunion After Intramedullary Nailing. Am J Biomed Life Sci. 2022;10(2):55-57. doi: 10.11648/j.ajbls.20221002.19

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@article{10.11648/j.ajbls.20221002.19,
  author = {Haytham Hemeda and Osama Essawy},
  title = {Outcome of Plate Augmentation in Management of Tibial Nonunion After Intramedullary Nailing},
  journal = {American Journal of Biomedical and Life Sciences},
  volume = {10},
  number = {2},
  pages = {55-57},
  doi = {10.11648/j.ajbls.20221002.19},
  url = {https://doi.org/10.11648/j.ajbls.20221002.19},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajbls.20221002.19},
  abstract = {Background: Despite the multitude of studies on non union no clear criterion has been established for declaring a fracture as non united. A diagnosis of non union is unjustified, however, until clinical or radiographic evidence shows that healing has ceased and that union is highly improbable. A fracture of the shaft of a long bone should not be considered a non union until at least 6 months after the injury. The incidence of non union in the long bone varies with each bone and with methods of treating acute fractures. More recently, the tibia probably is the most frequent site of non union. Nonunion following intramedullary fixation of tibial fractures is a challenge. Although reamed exchange nailing results are encouraging with union rates, exchange nailing could be extremely challenging due to situations when nail removal is difficult. Augmentation plates gained popularity in management of femoral nonunion with few reports in tibial nonunion. The aim of the current study is to present our results in augmentation plate in management of tibial nonunion with intramedullary nail. Patient and methods: From 2017 till 2021, 20 cases of nonunited tibial fractures fixed by IM nails was included. Augmentation plate without removing the nail in addition of autogenous iliac graft. Results: Union was obtained in all the cases (20 cases) in an average time of about 6.22 months (range 3-12 months). Complications are few included 3 casea of superficial infection and parasthesia at iliac graft site. Conclusion: Plate augmentation without removal of IM nail is a good option in management of aseptic nonunion tibia with excellent results and few complications.},
 year = {2022}
}

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TY - JOUR
T1 - Outcome of Plate Augmentation in Management of Tibial Nonunion After Intramedullary Nailing
AU - Haytham Hemeda
AU - Osama Essawy
Y1 - 2022/04/26
PY - 2022
N1 - https://doi.org/10.11648/j.ajbls.20221002.19
DO - 10.11648/j.ajbls.20221002.19
T2 - American Journal of Biomedical and Life Sciences
JF - American Journal of Biomedical and Life Sciences
JO - American Journal of Biomedical and Life Sciences
SP - 55
EP - 57
PB - Science Publishing Group
SN - 2330-880X
UR - https://doi.org/10.11648/j.ajbls.20221002.19
AB - Background: Despite the multitude of studies on non union no clear criterion has been established for declaring a fracture as non united. A diagnosis of non union is unjustified, however, until clinical or radiographic evidence shows that healing has ceased and that union is highly improbable. A fracture of the shaft of a long bone should not be considered a non union until at least 6 months after the injury. The incidence of non union in the long bone varies with each bone and with methods of treating acute fractures. More recently, the tibia probably is the most frequent site of non union. Nonunion following intramedullary fixation of tibial fractures is a challenge. Although reamed exchange nailing results are encouraging with union rates, exchange nailing could be extremely challenging due to situations when nail removal is difficult. Augmentation plates gained popularity in management of femoral nonunion with few reports in tibial nonunion. The aim of the current study is to present our results in augmentation plate in management of tibial nonunion with intramedullary nail. Patient and methods: From 2017 till 2021, 20 cases of nonunited tibial fractures fixed by IM nails was included. Augmentation plate without removing the nail in addition of autogenous iliac graft. Results: Union was obtained in all the cases (20 cases) in an average time of about 6.22 months (range 3-12 months). Complications are few included 3 casea of superficial infection and parasthesia at iliac graft site. Conclusion: Plate augmentation without removal of IM nail is a good option in management of aseptic nonunion tibia with excellent results and few complications.
VL - 10
IS - 2
ER -

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Author Information

Haytham Hemeda

Orthopedic Department, Benha Universty, Benha, Egypt
Osama Essawy

Orthopedic Department, Benha Universty, Benha, Egypt

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APA Style

Haytham Hemeda, Osama Essawy. (2022). Outcome of Plate Augmentation in Management of Tibial Nonunion After Intramedullary Nailing. American Journal of Biomedical and Life Sciences, 10(2), 55-57. https://doi.org/10.11648/j.ajbls.20221002.19

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ACS Style

Haytham Hemeda; Osama Essawy. Outcome of Plate Augmentation in Management of Tibial Nonunion After Intramedullary Nailing. Am. J. Biomed. Life Sci. 2022, 10(2), 55-57. doi: 10.11648/j.ajbls.20221002.19

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AMA Style

Haytham Hemeda, Osama Essawy. Outcome of Plate Augmentation in Management of Tibial Nonunion After Intramedullary Nailing. Am J Biomed Life Sci. 2022;10(2):55-57. doi: 10.11648/j.ajbls.20221002.19

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@article{10.11648/j.ajbls.20221002.19,
  author = {Haytham Hemeda and Osama Essawy},
  title = {Outcome of Plate Augmentation in Management of Tibial Nonunion After Intramedullary Nailing},
  journal = {American Journal of Biomedical and Life Sciences},
  volume = {10},
  number = {2},
  pages = {55-57},
  doi = {10.11648/j.ajbls.20221002.19},
  url = {https://doi.org/10.11648/j.ajbls.20221002.19},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajbls.20221002.19},
  abstract = {Background: Despite the multitude of studies on non union no clear criterion has been established for declaring a fracture as non united. A diagnosis of non union is unjustified, however, until clinical or radiographic evidence shows that healing has ceased and that union is highly improbable. A fracture of the shaft of a long bone should not be considered a non union until at least 6 months after the injury. The incidence of non union in the long bone varies with each bone and with methods of treating acute fractures. More recently, the tibia probably is the most frequent site of non union. Nonunion following intramedullary fixation of tibial fractures is a challenge. Although reamed exchange nailing results are encouraging with union rates, exchange nailing could be extremely challenging due to situations when nail removal is difficult. Augmentation plates gained popularity in management of femoral nonunion with few reports in tibial nonunion. The aim of the current study is to present our results in augmentation plate in management of tibial nonunion with intramedullary nail. Patient and methods: From 2017 till 2021, 20 cases of nonunited tibial fractures fixed by IM nails was included. Augmentation plate without removing the nail in addition of autogenous iliac graft. Results: Union was obtained in all the cases (20 cases) in an average time of about 6.22 months (range 3-12 months). Complications are few included 3 casea of superficial infection and parasthesia at iliac graft site. Conclusion: Plate augmentation without removal of IM nail is a good option in management of aseptic nonunion tibia with excellent results and few complications.},
 year = {2022}
}

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